New Student Form - Preceptor Connect

Provide us some information about your needs and what you are looking for in a preceptor

We will match you with your perfect preceptor and contact you

Get in contact with your preceptor and begin your clinical rotation

First Name *

Last Name *

Gender *

Email *

Phone *

City of Residence *

State of Residence *

University *

City of University *

State of University *

Expected Date of Graduation *

Select your field of study *

Number of clinical hours needed *

Clinical Rotation Start Date *

What is the date when you are allowed by your university to begin your clinical rotation?

Rotation Preference *

Please keep in mind that your university may not allow telehealth and/or hybrid. Be sure to confirm with your school

Are you willing to travel? *

Years of preceptor experience required *

Some schools require that your preceptor must have a certain amount of professional experience

Additional Comments

Please let us know if you have any additional comments or you'd like to clarify any of your responses